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Home My WebLink AboutBLD2013-00037 *BUILDING PERMIT APPLIC•ON BLD13-00037 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00037 Received Date: 1/29/2013 SITE ADDRESS: HIGHLAND DR PORT LUDLOW, 98365 OWNER: AUGUST W CLAVEY PHONE: 360-437-5099 22808 N DUSTY TRAIL BLVD SUN CITY WEST AZ 85375-2044 SOUTH BAY#1 SUBDIVISION: Block: Lot: 16 PARCEL NUMBER: 995500016 Section: 21 Township: 28 N Range: 01 E CONTRACTOR: BRENNAN HTG &A/C LLC PHONE: 206-248-7900 4601 S 134TH PL SEATTLE WA 98168 Contractor's License BRENNHA971 R9 Expires 12/29/2013 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI HEAT PUMP TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 11,111.00 ADD'L: HEAT TYPE: CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $228.00 LYK 01/29/13 139954 APPROVED Total: $228.00 JAN 2 9 2013 Jefferson County DCC \\4iiicmnr4\rlo4,\fnrme\G RI n Ann RIHI rn4 1/9Q/9A14 JEFFERSSCOUNTY pg o # kiiiirA DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: ect Dpscription(include sepacate sheets a necessary): 'k cK) Tax Parcel Number: L Property Size: (acres/square feet)_ Site Address and/or Directions to Prope : u 1 okl,\��. Dc Qr L J\ L q Property Owner(s)of Record: r►YY\ m ti, Q Telephone: b • Ll.3- t-DiockcA Fax: email: Mailing Address: — Applicant!;!ent(if different from owner): _` li• C. t' ;* ,k !AI %Y Telephone._1 • •_ is A II F x: p email: !: �►` ,r_ I#` e . Mailing Address: b t 1 L- r; A 1-t J A IAA., yy- What kind of Permit?(Check each box that applies ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) ,,28ingle Family ❑Garage Attached/Detached ❑Conditional Use[d(a) I r ❑ Manufactured Home ❑ Modular ❑Discretionary"D"or, • �- s=••.: i.� !rf ❑ Commercial* 0 Special Use(Essential Ptt� - �.., .��sn ❑ Change of Use ❑Boundary Line Adjustment ❑ Address ❑Road Approach ❑Short Plat'* -4 ❑Home Business ❑Cottage Industry ❑Binding Site Plan* p, 9 2013 i ❑Propane ❑Long Plat** ❑Sign ❑Planned Rural Reskienttl Development(PRRDyAm is** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** JEFF RSO i. OUN ❑Stormwater Management ❑Shoreline'Master Program ��• ,;1 11 �; ',r;• s** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management S • = = - ❑Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference ❑Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: ESIGNATION OF AGENT I hereby designate A. 2 ! 0, to act as my gen matters relatin to this application for permit(s). OWNER SIGNATURE _ _ f t By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,Indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorneys fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that he or she wants prior notice. Signature: Date: The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the appfcant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: G:\PeanitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc IF: . _ i • BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: ENERAL CONTRACTOR OR ANUFACTURED HOME INSTALLER: PHONE: FAX: ! J. .. %.A. �s L d L �! ( 0' , A • 00 ( C) q(6t 0 _ 5 MAILING ADDRESS: �'.. 3 ,- r t ui�.. EMAIL: l y. " . i f ,r eta ♦ ' `_' CONTRACTOR'S LICENSE CJ(, #, 0 t I • ! °V INS ( NUMBER: NUMBER M ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: ' EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: O New 0 Wood Existing: ❑ Sewer o Addition 0 Steel Proposed: — Bank ❑ Community System .o'"iteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 Two Party Type of eat: Proposed: o Public trC__, Total: Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: 1 Underground Tank 1 Above ground Tank Size of Propane Tank: 1 Heat Stove 1 Cook Stove I Woodstove I Fireplace Insert 1 Hot Water Tank I Pellet Stove I Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying fora permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components, Including the reserve area. S•uare Foota•e Current Pro•osed F r i , ' fi� f:., 'LW Ilz...l,._ f}: . ,ii ,L_, . _..-,:. Main Floor Heated , k 1i ,k-t,4 EH Bid App Review: 2"0 Floor Heated Consistency Review: Other Heated ` ' + Base fee: g, ti Mezzanine �� Additional Section: Heated Basement ' yy F•• • Plan Check few Unheated Basement t £k'' ,<. State Surcharge fee: Other Unheated ;" ' , Pot Water Review fee: , un a r ,- a Garage/Carport f, .• t \ T Decks -.f-9.._11,41 i !9 1r d Approach fee: — 1 Other r J A ITOTA.: 2113 i x � R 1 J ;ray He ;mat Number. 0'41r ..t,i,, .- ,,,,,,,,!,' - _ ,'Cash!Check 4 6i ',_ _ otair � {r,, ^r' of COVNUNI DEUEI. ESTIMATED COST(REQUIRED) Date: 1-- _q��-- .Fair market value of all labor and materials foundation to finish �1 Initials: C■ G.\PemvtCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc 0 e . MECHANICAL AND DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD13-00037 Received Date 1/29/2013 SITE ADDRESS: HIGHLAND DR Issue Date 1/29/2013 PORT LUDLOW, 98365 APPLICANT: AUGUST W CLAVEY PHONE: 360-437-5099 22808 N DUSTY TRAIL BLVD SUN CITY WEST AZ 85375-2044 16 SUBDIVISION: SOUTH BAY#1 Block: Lot: PARCEL NUMBER: 995500016 Section: 21 Township: 28N Range: 01E CONTRACTOR: BRENNAN HTG &NC LLC PHONE: 206-248-7900 4601 S 134TH PL SEATTLE WA 98168 Contractor's License BRENNHA971R9 Expires 12/29/2013 OWNER, AUGUST W CLAVEY PHONE: 360-437-5099 if different: 22808 N DUSTY TRAIL BLVD SUN CITY WEST AZ 85375-2044 PROJECT DESCRIPTION: HEAT PUMP Directions To Site: THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 1/29/2014. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: :2-161I BUILDING INSPECTION HOT-LINE 379-4455. REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFORE THE INSPECTION IS NEEDED. Office Hours 9:00 a.m. -4:30 p.m. Monday-Thursday HOT LINE AVAILABLE 24 HOURS A DAY \\tidemark\data\forms\F_BLD_Permit_Propane.rpt 1/29/2013